High Prevalence and Burden of Physical and Psychological Symptoms in a Chronic Obstructive Pulmonary Disease Population in Primary Care Settings in South Africa

Kennedy B Nkhoma; Lindsay Farrant; Olona Mzimkulu; Joy Hunter; Irene Higginson; Wei Gao; Matthew Maddocks; Liz Gwyther; Richard Harding

doi:10.2147/COPD.S395834

High Prevalence and Burden of Physical and Psychological Symptoms in a Chronic Obstructive Pulmonary Disease Population in Primary Care Settings in South Africa

Int J Chron Obstruct Pulmon Dis. 2023 Aug 2:18:1665-1679. doi: 10.2147/COPD.S395834. eCollection 2023.

Authors

Kennedy B Nkhoma¹, Lindsay Farrant², Olona Mzimkulu², Joy Hunter², Irene Higginson¹, Wei Gao², Matthew Maddocks¹, Liz Gwyther², Richard Harding¹

Affiliations

¹ Cicely Saunders Institute of Palliative Care Policy and Rehabilitation, King's College London, London, UK.
² Division of Interdisciplinary Palliative Care & Medicine, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Abstract

Background: Many deaths globally are attributable to non-communicable disease, and four-fifths of these deaths are in low- and middle-income countries. Globally, COPD is currently the third leading cause of mortality.

Research question: 1) To determine the prevalence and burden of symptoms and concerns, and 2) determine predicting factors of symptom burden among patients with COPD.

Methods: A cross-sectional survey was conducted at eight primary care sites in Western Cape. We collected socio-demographic data (age, gender, smoking status, number of missed doses of prescribed medication in the last seven days) and clinical data (PEF and KPS). The Memorial Symptom Assessment Scale (MSAS), the Medical Outcomes Study, Social Support Survey (MOS-SSS), the London Chest Activity of Daily Living Scale (LCADLS) and the COPD Assessment Test (CAT) (impairment on person's life) were administered to patients. We conducted ordered logistic regression analysis to assess factors associated with the burden of symptoms. MSAS subscales: 1) Global symptom distress index, 2) physical symptom distress and 3) psychological symptom distress were dependent outcomes. We constructed three ordinal logistic regression models for each of the three subscales. Covariates were MOS-SSS, LCADLS, CAT, demographic and clinical variables.

Results: We recruited n=387 patients, mean age 59.5 years, 53.0% female. In multivariate analysis, each of the three models (ie, global, psychological and physical symptom distress) was positively associated with impairment on person's life p<0.001, difficulty to perform activities of daily living p<0.001, and low social support p<0.001. Old age was associated with lower global symptom distress (p=0.004), psychological and (0.014) physical distress (0.005). Missing 1 or more doses of medication was associated with higher levels of global (0.004) and physical (0.005) symptom distress.

Interpretation: The high prevalence and burden of physical and psychological symptoms provides strong evidence of the need for integrating person-centred assessment and management of symptoms in primary care settings.

Keywords: chronic lung disease; chronic obstructive pulmonary disease; symptom burden; symptom distress; symptom prevalence.

MeSH terms

Activities of Daily Living
Asthma*
Cross-Sectional Studies
Female
Humans
Male
Prevalence
Primary Health Care
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / drug therapy
Pulmonary Disease, Chronic Obstructive* / epidemiology
South Africa / epidemiology

Supplementary concepts

Pulmonary Disease, Chronic Obstructive, Severe Early-Onset

Grants and funding

This project was funded by National Institute of Health Research (NIHR) Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King’s College London (GHRU 16/136/54). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.